Alcoholism and Liver Disease

To the Editor.—  Through their comparative group selection, Ryback and co-workers have compromised their sophisticated analysis of biochemical and hematologic correlates of alcoholism and liver disease. These correlates would be more meaningful if they would allow distinction between alcoholics with alcoholic liver disease and alcoholics with nonalcoholic liver disease. Distinguishing alcoholic patients with liver disease often can be intimated by taking a history, as Ryback and associates have done in part by choosing their two major groups for study. They, in fact, may be identifying a pattern that reflects simultaneously both nonspecific liver disease and alcoholism rather than alcoholic liver disease per se. Moreover, their third group—patients in the alcoholic treatment program— may have had serious alcoholic or nonalcoholic hepatic disease without dramatic abnormalities in their laboratory test results.¹ Although the authors may not have felt justified in performing liver biopsies in these patients, this group remains a weak